|
URETHRAL STRICTURE
|
Facility
IP
|
$14,292.20
|
|
|
Service Code
|
MS-DRG 697
|
| Min. Negotiated Rate |
$10,549.65 |
| Max. Negotiated Rate |
$14,292.20 |
| Rate for Payer: Aetna Medicare |
$11,104.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,881.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,881.11
|
| Rate for Payer: BCBS MAPPO |
$11,104.89
|
| Rate for Payer: BCN Medicare Advantage |
$11,104.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,104.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,104.89
|
| Rate for Payer: Mclaren Medicare |
$11,104.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,660.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,770.62
|
| Rate for Payer: PACE Medicare |
$10,549.65
|
| Rate for Payer: PACE SWMI |
$11,104.89
|
| Rate for Payer: PHP Commercial |
$12,215.38
|
| Rate for Payer: PHP Medicare Advantage |
$11,104.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,292.20
|
| Rate for Payer: Priority Health Medicare |
$11,104.89
|
| Rate for Payer: Priority Health Narrow Network |
$11,433.76
|
| Rate for Payer: Railroad Medicare Medicare |
$11,104.89
|
| Rate for Payer: UHC Medicare Advantage |
$11,438.04
|
| Rate for Payer: VA VA |
$11,104.89
|
|
|
URINARY STONES WITH MCC
|
Facility
IP
|
$18,185.29
|
|
|
Service Code
|
MS-DRG 693
|
| Min. Negotiated Rate |
$12,988.30 |
| Max. Negotiated Rate |
$18,185.29 |
| Rate for Payer: Aetna Medicare |
$13,671.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,089.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,089.88
|
| Rate for Payer: BCBS MAPPO |
$13,671.90
|
| Rate for Payer: BCN Medicare Advantage |
$13,671.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,671.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,671.90
|
| Rate for Payer: Mclaren Medicare |
$13,671.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,355.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,722.68
|
| Rate for Payer: PACE Medicare |
$12,988.30
|
| Rate for Payer: PACE SWMI |
$13,671.90
|
| Rate for Payer: PHP Commercial |
$15,039.09
|
| Rate for Payer: PHP Medicare Advantage |
$13,671.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,185.29
|
| Rate for Payer: Priority Health Medicare |
$13,671.90
|
| Rate for Payer: Priority Health Narrow Network |
$14,548.23
|
| Rate for Payer: Railroad Medicare Medicare |
$13,671.90
|
| Rate for Payer: UHC Medicare Advantage |
$14,082.06
|
| Rate for Payer: VA VA |
$13,671.90
|
|
|
URINARY STONES WITHOUT MCC
|
Facility
IP
|
$10,384.49
|
|
|
Service Code
|
MS-DRG 694
|
| Min. Negotiated Rate |
$7,892.21 |
| Max. Negotiated Rate |
$10,384.49 |
| Rate for Payer: Aetna Medicare |
$8,307.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,384.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,384.49
|
| Rate for Payer: BCBS MAPPO |
$8,307.59
|
| Rate for Payer: BCN Medicare Advantage |
$8,307.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,307.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,307.59
|
| Rate for Payer: Mclaren Medicare |
$8,307.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,722.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,553.73
|
| Rate for Payer: PACE Medicare |
$7,892.21
|
| Rate for Payer: PACE SWMI |
$8,307.59
|
| Rate for Payer: PHP Commercial |
$9,138.35
|
| Rate for Payer: PHP Medicare Advantage |
$8,307.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,049.87
|
| Rate for Payer: Priority Health Medicare |
$8,307.59
|
| Rate for Payer: Priority Health Narrow Network |
$8,039.90
|
| Rate for Payer: Railroad Medicare Medicare |
$8,307.59
|
| Rate for Payer: UHC Medicare Advantage |
$8,556.82
|
| Rate for Payer: VA VA |
$8,307.59
|
|
|
URINARY SUSPENSORY
|
Professional
|
$65.00
|
|
|
Service Code
|
HCPCS A5105
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Aetna Commercial |
$37.97
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCN Commercial |
$44.89
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC
|
Facility
IP
|
$22,879.60
|
|
|
Service Code
|
MS-DRG 742
|
| Min. Negotiated Rate |
$15,928.85 |
| Max. Negotiated Rate |
$22,879.60 |
| Rate for Payer: Aetna Medicare |
$16,767.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,959.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,959.01
|
| Rate for Payer: BCBS MAPPO |
$16,767.21
|
| Rate for Payer: BCN Medicare Advantage |
$16,767.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,767.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,767.21
|
| Rate for Payer: Mclaren Medicare |
$16,767.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,605.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,282.29
|
| Rate for Payer: PACE Medicare |
$15,928.85
|
| Rate for Payer: PACE SWMI |
$16,767.21
|
| Rate for Payer: PHP Commercial |
$18,443.93
|
| Rate for Payer: PHP Medicare Advantage |
$16,767.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,879.60
|
| Rate for Payer: Priority Health Medicare |
$16,767.21
|
| Rate for Payer: Priority Health Narrow Network |
$18,303.68
|
| Rate for Payer: Railroad Medicare Medicare |
$16,767.21
|
| Rate for Payer: UHC Medicare Advantage |
$17,270.23
|
| Rate for Payer: VA VA |
$16,767.21
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$14,920.08
|
|
|
Service Code
|
MS-DRG 743
|
| Min. Negotiated Rate |
$10,942.95 |
| Max. Negotiated Rate |
$14,920.08 |
| Rate for Payer: Aetna Medicare |
$11,518.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,398.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,398.61
|
| Rate for Payer: BCBS MAPPO |
$11,518.89
|
| Rate for Payer: BCN Medicare Advantage |
$11,518.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,518.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,518.89
|
| Rate for Payer: Mclaren Medicare |
$11,518.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,094.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,246.72
|
| Rate for Payer: PACE Medicare |
$10,942.95
|
| Rate for Payer: PACE SWMI |
$11,518.89
|
| Rate for Payer: PHP Commercial |
$12,670.78
|
| Rate for Payer: PHP Medicare Advantage |
$11,518.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,920.08
|
| Rate for Payer: Priority Health Medicare |
$11,518.89
|
| Rate for Payer: Priority Health Narrow Network |
$11,936.06
|
| Rate for Payer: Railroad Medicare Medicare |
$11,518.89
|
| Rate for Payer: UHC Medicare Advantage |
$11,864.46
|
| Rate for Payer: VA VA |
$11,518.89
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC
|
Facility
IP
|
$22,945.08
|
|
|
Service Code
|
MS-DRG 740
|
| Min. Negotiated Rate |
$15,969.87 |
| Max. Negotiated Rate |
$22,945.08 |
| Rate for Payer: Aetna Medicare |
$16,810.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,012.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,012.99
|
| Rate for Payer: BCBS MAPPO |
$16,810.39
|
| Rate for Payer: BCN Medicare Advantage |
$16,810.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,810.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,810.39
|
| Rate for Payer: Mclaren Medicare |
$16,810.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,650.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,331.95
|
| Rate for Payer: PACE Medicare |
$15,969.87
|
| Rate for Payer: PACE SWMI |
$16,810.39
|
| Rate for Payer: PHP Commercial |
$18,491.43
|
| Rate for Payer: PHP Medicare Advantage |
$16,810.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,945.08
|
| Rate for Payer: Priority Health Medicare |
$16,810.39
|
| Rate for Payer: Priority Health Narrow Network |
$18,356.06
|
| Rate for Payer: Railroad Medicare Medicare |
$16,810.39
|
| Rate for Payer: UHC Medicare Advantage |
$17,314.70
|
| Rate for Payer: VA VA |
$16,810.39
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC
|
Facility
IP
|
$46,433.29
|
|
|
Service Code
|
MS-DRG 739
|
| Min. Negotiated Rate |
$30,683.06 |
| Max. Negotiated Rate |
$46,433.29 |
| Rate for Payer: Aetna Medicare |
$32,297.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40,372.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40,372.45
|
| Rate for Payer: BCBS MAPPO |
$32,297.96
|
| Rate for Payer: BCN Medicare Advantage |
$32,297.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,297.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$32,297.96
|
| Rate for Payer: Mclaren Medicare |
$32,297.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33,912.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,142.65
|
| Rate for Payer: PACE Medicare |
$30,683.06
|
| Rate for Payer: PACE SWMI |
$32,297.96
|
| Rate for Payer: PHP Commercial |
$35,527.76
|
| Rate for Payer: PHP Medicare Advantage |
$32,297.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46,433.29
|
| Rate for Payer: Priority Health Medicare |
$32,297.96
|
| Rate for Payer: Priority Health Narrow Network |
$37,146.63
|
| Rate for Payer: Railroad Medicare Medicare |
$32,297.96
|
| Rate for Payer: UHC Medicare Advantage |
$33,266.90
|
| Rate for Payer: VA VA |
$32,297.96
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$16,683.01
|
|
|
Service Code
|
MS-DRG 741
|
| Min. Negotiated Rate |
$12,047.26 |
| Max. Negotiated Rate |
$16,683.01 |
| Rate for Payer: Aetna Medicare |
$12,681.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,851.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,851.66
|
| Rate for Payer: BCBS MAPPO |
$12,681.33
|
| Rate for Payer: BCN Medicare Advantage |
$12,681.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,681.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,681.33
|
| Rate for Payer: Mclaren Medicare |
$12,681.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,315.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,583.53
|
| Rate for Payer: PACE Medicare |
$12,047.26
|
| Rate for Payer: PACE SWMI |
$12,681.33
|
| Rate for Payer: PHP Commercial |
$13,949.46
|
| Rate for Payer: PHP Medicare Advantage |
$12,681.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,683.01
|
| Rate for Payer: Priority Health Medicare |
$12,681.33
|
| Rate for Payer: Priority Health Narrow Network |
$13,346.41
|
| Rate for Payer: Railroad Medicare Medicare |
$12,681.33
|
| Rate for Payer: UHC Medicare Advantage |
$13,061.77
|
| Rate for Payer: VA VA |
$12,681.33
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC
|
Facility
IP
|
$25,343.59
|
|
|
Service Code
|
MS-DRG 737
|
| Min. Negotiated Rate |
$17,472.30 |
| Max. Negotiated Rate |
$25,343.59 |
| Rate for Payer: Aetna Medicare |
$18,391.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,989.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,989.88
|
| Rate for Payer: BCBS MAPPO |
$18,391.90
|
| Rate for Payer: BCN Medicare Advantage |
$18,391.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,391.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,391.90
|
| Rate for Payer: Mclaren Medicare |
$18,391.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,311.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,150.68
|
| Rate for Payer: PACE Medicare |
$17,472.30
|
| Rate for Payer: PACE SWMI |
$18,391.90
|
| Rate for Payer: PHP Commercial |
$20,231.09
|
| Rate for Payer: PHP Medicare Advantage |
$18,391.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,343.59
|
| Rate for Payer: Priority Health Medicare |
$18,391.90
|
| Rate for Payer: Priority Health Narrow Network |
$20,274.87
|
| Rate for Payer: Railroad Medicare Medicare |
$18,391.90
|
| Rate for Payer: UHC Medicare Advantage |
$18,943.66
|
| Rate for Payer: VA VA |
$18,391.90
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC
|
Facility
IP
|
$49,911.65
|
|
|
Service Code
|
MS-DRG 736
|
| Min. Negotiated Rate |
$32,861.93 |
| Max. Negotiated Rate |
$49,911.65 |
| Rate for Payer: Aetna Medicare |
$34,591.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,239.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,239.39
|
| Rate for Payer: BCBS MAPPO |
$34,591.51
|
| Rate for Payer: BCN Medicare Advantage |
$34,591.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,591.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$34,591.51
|
| Rate for Payer: Mclaren Medicare |
$34,591.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36,321.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39,780.24
|
| Rate for Payer: PACE Medicare |
$32,861.93
|
| Rate for Payer: PACE SWMI |
$34,591.51
|
| Rate for Payer: PHP Commercial |
$38,050.66
|
| Rate for Payer: PHP Medicare Advantage |
$34,591.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49,911.65
|
| Rate for Payer: Priority Health Medicare |
$34,591.51
|
| Rate for Payer: Priority Health Narrow Network |
$39,929.32
|
| Rate for Payer: Railroad Medicare Medicare |
$34,591.51
|
| Rate for Payer: UHC Medicare Advantage |
$35,629.26
|
| Rate for Payer: VA VA |
$34,591.51
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$17,521.46
|
|
|
Service Code
|
MS-DRG 738
|
| Min. Negotiated Rate |
$12,572.48 |
| Max. Negotiated Rate |
$17,521.46 |
| Rate for Payer: Aetna Medicare |
$13,234.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,542.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,542.74
|
| Rate for Payer: BCBS MAPPO |
$13,234.19
|
| Rate for Payer: BCN Medicare Advantage |
$13,234.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,234.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,234.19
|
| Rate for Payer: Mclaren Medicare |
$13,234.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,895.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,219.32
|
| Rate for Payer: PACE Medicare |
$12,572.48
|
| Rate for Payer: PACE SWMI |
$13,234.19
|
| Rate for Payer: PHP Commercial |
$14,557.61
|
| Rate for Payer: PHP Medicare Advantage |
$13,234.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,521.46
|
| Rate for Payer: Priority Health Medicare |
$13,234.19
|
| Rate for Payer: Priority Health Narrow Network |
$14,017.17
|
| Rate for Payer: Railroad Medicare Medicare |
$13,234.19
|
| Rate for Payer: UHC Medicare Advantage |
$13,631.22
|
| Rate for Payer: VA VA |
$13,234.19
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC
|
Facility
IP
|
$21,521.12
|
|
|
Service Code
|
MS-DRG 746
|
| Min. Negotiated Rate |
$15,077.89 |
| Max. Negotiated Rate |
$21,521.12 |
| Rate for Payer: Aetna Medicare |
$15,871.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,839.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,839.32
|
| Rate for Payer: BCBS MAPPO |
$15,871.46
|
| Rate for Payer: BCN Medicare Advantage |
$15,871.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,871.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,871.46
|
| Rate for Payer: Mclaren Medicare |
$15,871.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,665.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,252.18
|
| Rate for Payer: PACE Medicare |
$15,077.89
|
| Rate for Payer: PACE SWMI |
$15,871.46
|
| Rate for Payer: PHP Commercial |
$17,458.61
|
| Rate for Payer: PHP Medicare Advantage |
$15,871.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,521.12
|
| Rate for Payer: Priority Health Medicare |
$15,871.46
|
| Rate for Payer: Priority Health Narrow Network |
$17,216.90
|
| Rate for Payer: Railroad Medicare Medicare |
$15,871.46
|
| Rate for Payer: UHC Medicare Advantage |
$16,347.60
|
| Rate for Payer: VA VA |
$15,871.46
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$11,490.39
|
|
|
Service Code
|
MS-DRG 747
|
| Min. Negotiated Rate |
$8,732.69 |
| Max. Negotiated Rate |
$11,490.39 |
| Rate for Payer: Aetna Medicare |
$9,192.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,490.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,490.39
|
| Rate for Payer: BCBS MAPPO |
$9,192.31
|
| Rate for Payer: BCN Medicare Advantage |
$9,192.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,192.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,192.31
|
| Rate for Payer: Mclaren Medicare |
$9,192.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,651.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,571.16
|
| Rate for Payer: PACE Medicare |
$8,732.69
|
| Rate for Payer: PACE SWMI |
$9,192.31
|
| Rate for Payer: PHP Commercial |
$10,111.54
|
| Rate for Payer: PHP Medicare Advantage |
$9,192.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,391.65
|
| Rate for Payer: Priority Health Medicare |
$9,192.31
|
| Rate for Payer: Priority Health Narrow Network |
$9,113.32
|
| Rate for Payer: Railroad Medicare Medicare |
$9,192.31
|
| Rate for Payer: UHC Medicare Advantage |
$9,468.08
|
| Rate for Payer: VA VA |
$9,192.31
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C
|
Facility
IP
|
$15,640.40
|
|
|
Service Code
|
MS-DRG 768
|
| Min. Negotiated Rate |
$11,394.16 |
| Max. Negotiated Rate |
$15,640.40 |
| Rate for Payer: Aetna Medicare |
$11,993.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,992.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,992.31
|
| Rate for Payer: BCBS MAPPO |
$11,993.85
|
| Rate for Payer: BCN Medicare Advantage |
$11,993.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,993.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,993.85
|
| Rate for Payer: Mclaren Medicare |
$11,993.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,593.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,792.93
|
| Rate for Payer: PACE Medicare |
$11,394.16
|
| Rate for Payer: PACE SWMI |
$11,993.85
|
| Rate for Payer: PHP Commercial |
$13,193.24
|
| Rate for Payer: PHP Medicare Advantage |
$11,993.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,640.40
|
| Rate for Payer: Priority Health Medicare |
$11,993.85
|
| Rate for Payer: Priority Health Narrow Network |
$12,512.32
|
| Rate for Payer: Railroad Medicare Medicare |
$11,993.85
|
| Rate for Payer: UHC Medicare Advantage |
$12,353.67
|
| Rate for Payer: VA VA |
$11,993.85
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC
|
Facility
IP
|
$10,003.50
|
|
|
Service Code
|
MS-DRG 806
|
| Min. Negotiated Rate |
$7,602.66 |
| Max. Negotiated Rate |
$10,003.50 |
| Rate for Payer: Aetna Medicare |
$8,002.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,003.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,003.50
|
| Rate for Payer: BCBS MAPPO |
$8,002.80
|
| Rate for Payer: BCN Medicare Advantage |
$8,002.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,002.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,002.80
|
| Rate for Payer: Mclaren Medicare |
$8,002.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,402.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,203.22
|
| Rate for Payer: PACE Medicare |
$7,602.66
|
| Rate for Payer: PACE SWMI |
$8,002.80
|
| Rate for Payer: PHP Commercial |
$8,803.08
|
| Rate for Payer: PHP Medicare Advantage |
$8,002.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,587.63
|
| Rate for Payer: Priority Health Medicare |
$8,002.80
|
| Rate for Payer: Priority Health Narrow Network |
$7,670.10
|
| Rate for Payer: Railroad Medicare Medicare |
$8,002.80
|
| Rate for Payer: UHC Medicare Advantage |
$8,242.88
|
| Rate for Payer: VA VA |
$8,002.80
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC
|
Facility
IP
|
$12,945.29
|
|
|
Service Code
|
MS-DRG 805
|
| Min. Negotiated Rate |
$9,705.92 |
| Max. Negotiated Rate |
$12,945.29 |
| Rate for Payer: Aetna Medicare |
$10,216.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,770.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,770.95
|
| Rate for Payer: BCBS MAPPO |
$10,216.76
|
| Rate for Payer: BCN Medicare Advantage |
$10,216.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,216.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,216.76
|
| Rate for Payer: Mclaren Medicare |
$10,216.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,727.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,749.27
|
| Rate for Payer: PACE Medicare |
$9,705.92
|
| Rate for Payer: PACE SWMI |
$10,216.76
|
| Rate for Payer: PHP Commercial |
$11,238.44
|
| Rate for Payer: PHP Medicare Advantage |
$10,216.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,945.29
|
| Rate for Payer: Priority Health Medicare |
$10,216.76
|
| Rate for Payer: Priority Health Narrow Network |
$10,356.23
|
| Rate for Payer: Railroad Medicare Medicare |
$10,216.76
|
| Rate for Payer: UHC Medicare Advantage |
$10,523.26
|
| Rate for Payer: VA VA |
$10,216.76
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
IP
|
$9,025.62
|
|
|
Service Code
|
MS-DRG 807
|
| Min. Negotiated Rate |
$6,720.97 |
| Max. Negotiated Rate |
$9,025.62 |
| Rate for Payer: Aetna Medicare |
$7,220.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,025.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,025.62
|
| Rate for Payer: BCBS MAPPO |
$7,220.50
|
| Rate for Payer: BCN Medicare Advantage |
$7,220.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,220.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,220.50
|
| Rate for Payer: Mclaren Medicare |
$7,220.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,581.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,303.58
|
| Rate for Payer: PACE Medicare |
$6,859.48
|
| Rate for Payer: PACE SWMI |
$7,220.50
|
| Rate for Payer: PHP Commercial |
$7,942.55
|
| Rate for Payer: PHP Medicare Advantage |
$7,220.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,401.21
|
| Rate for Payer: Priority Health Medicare |
$7,220.50
|
| Rate for Payer: Priority Health Narrow Network |
$6,720.97
|
| Rate for Payer: Railroad Medicare Medicare |
$7,220.50
|
| Rate for Payer: UHC Medicare Advantage |
$7,437.12
|
| Rate for Payer: VA VA |
$7,220.50
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
IP
|
$12,787.36
|
|
|
Service Code
|
MS-DRG 797
|
| Min. Negotiated Rate |
$9,607.00 |
| Max. Negotiated Rate |
$12,787.36 |
| Rate for Payer: Aetna Medicare |
$10,112.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,640.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,640.79
|
| Rate for Payer: BCBS MAPPO |
$10,112.63
|
| Rate for Payer: BCN Medicare Advantage |
$10,112.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,112.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,112.63
|
| Rate for Payer: Mclaren Medicare |
$10,112.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,618.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,629.52
|
| Rate for Payer: PACE Medicare |
$9,607.00
|
| Rate for Payer: PACE SWMI |
$10,112.63
|
| Rate for Payer: PHP Commercial |
$11,123.89
|
| Rate for Payer: PHP Medicare Advantage |
$10,112.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,787.36
|
| Rate for Payer: Priority Health Medicare |
$10,112.63
|
| Rate for Payer: Priority Health Narrow Network |
$10,229.89
|
| Rate for Payer: Railroad Medicare Medicare |
$10,112.63
|
| Rate for Payer: UHC Medicare Advantage |
$10,416.01
|
| Rate for Payer: VA VA |
$10,112.63
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
IP
|
$18,212.26
|
|
|
Service Code
|
MS-DRG 796
|
| Min. Negotiated Rate |
$13,005.20 |
| Max. Negotiated Rate |
$18,212.26 |
| Rate for Payer: Aetna Medicare |
$13,689.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,112.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,112.10
|
| Rate for Payer: BCBS MAPPO |
$13,689.68
|
| Rate for Payer: BCN Medicare Advantage |
$13,689.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,689.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,689.68
|
| Rate for Payer: Mclaren Medicare |
$13,689.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,374.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,743.13
|
| Rate for Payer: PACE Medicare |
$13,005.20
|
| Rate for Payer: PACE SWMI |
$13,689.68
|
| Rate for Payer: PHP Commercial |
$15,058.65
|
| Rate for Payer: PHP Medicare Advantage |
$13,689.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,212.26
|
| Rate for Payer: Priority Health Medicare |
$13,689.68
|
| Rate for Payer: Priority Health Narrow Network |
$14,569.81
|
| Rate for Payer: Railroad Medicare Medicare |
$13,689.68
|
| Rate for Payer: UHC Medicare Advantage |
$14,100.37
|
| Rate for Payer: VA VA |
$13,689.68
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
IP
|
$10,939.04
|
|
|
Service Code
|
MS-DRG 798
|
| Min. Negotiated Rate |
$8,313.67 |
| Max. Negotiated Rate |
$10,939.04 |
| Rate for Payer: Aetna Medicare |
$8,751.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,939.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,939.04
|
| Rate for Payer: BCBS MAPPO |
$8,751.23
|
| Rate for Payer: BCN Medicare Advantage |
$8,751.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,751.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,751.23
|
| Rate for Payer: Mclaren Medicare |
$8,751.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,188.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,063.91
|
| Rate for Payer: PACE Medicare |
$8,313.67
|
| Rate for Payer: PACE SWMI |
$8,751.23
|
| Rate for Payer: PHP Commercial |
$9,626.35
|
| Rate for Payer: PHP Medicare Advantage |
$8,751.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,415.81
|
| Rate for Payer: Priority Health Medicare |
$8,751.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,332.65
|
| Rate for Payer: Railroad Medicare Medicare |
$8,751.23
|
| Rate for Payer: UHC Medicare Advantage |
$9,013.77
|
| Rate for Payer: VA VA |
$8,751.23
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$106.02
|
|
|
Service Code
|
NDC 0378-4275-93
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.21 |
| Max. Negotiated Rate |
$106.02 |
| Rate for Payer: Aetna Commercial |
$95.42
|
| Rate for Payer: ASR ASR |
$102.84
|
| Rate for Payer: BCBS Trust/PPO |
$82.20
|
| Rate for Payer: BCN Commercial |
$82.20
|
| Rate for Payer: Cash Price |
$84.82
|
| Rate for Payer: Cofinity Commercial |
$99.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.82
|
| Rate for Payer: Healthscope Commercial |
$106.02
|
| Rate for Payer: Healthscope Whirlpool |
$102.84
|
| Rate for Payer: Mclaren Commercial |
$95.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.30
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$6.09
|
|
|
Service Code
|
NDC 50268-788-11
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$6.09 |
| Rate for Payer: Aetna Commercial |
$5.48
|
| Rate for Payer: ASR ASR |
$5.91
|
| Rate for Payer: BCBS Trust/PPO |
$4.72
|
| Rate for Payer: BCN Commercial |
$4.72
|
| Rate for Payer: Cash Price |
$4.87
|
| Rate for Payer: Cofinity Commercial |
$5.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.87
|
| Rate for Payer: Healthscope Commercial |
$6.09
|
| Rate for Payer: Healthscope Whirlpool |
$5.91
|
| Rate for Payer: Mclaren Commercial |
$5.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.36
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$304.56
|
|
|
Service Code
|
NDC 50268-788-15
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.19 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$274.10
|
| Rate for Payer: ASR ASR |
$295.42
|
| Rate for Payer: BCBS Trust/PPO |
$236.13
|
| Rate for Payer: BCN Commercial |
$236.13
|
| Rate for Payer: Cash Price |
$243.65
|
| Rate for Payer: Cofinity Commercial |
$286.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.65
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Healthscope Whirlpool |
$295.42
|
| Rate for Payer: Mclaren Commercial |
$274.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.01
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$76.75
|
|
|
Service Code
|
NDC 59746-324-30
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.72 |
| Max. Negotiated Rate |
$76.75 |
| Rate for Payer: Aetna Commercial |
$69.08
|
| Rate for Payer: ASR ASR |
$74.45
|
| Rate for Payer: BCBS Trust/PPO |
$59.50
|
| Rate for Payer: BCN Commercial |
$59.50
|
| Rate for Payer: Cash Price |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$72.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.40
|
| Rate for Payer: Healthscope Commercial |
$76.75
|
| Rate for Payer: Healthscope Whirlpool |
$74.45
|
| Rate for Payer: Mclaren Commercial |
$69.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.54
|
|
